Why medication is only half the story.
What is AD(H)D and how can therapy help?
Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder is, as the name suggests, a condition that affects attention. It can occur with or without hyperactivity.
The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) states that children need to display “a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development.”
These attentional deficits and the hyperactivity are treated with medication.
The above is usually the knowledge and perception of ADD/ADHD within the general population.
This is not wrong, however, ADD/ADHD encompasses so much more and the symptoms of ADD/ADHD result in much more impairment than most people know of.
ADHD is estimated to affect 3–9% of school-aged children and young people in the UK (using DSM-5 diagnostic criteria) (NICE Guidelines)
The DSM-5, the ICD-10 as well as the NICE Guidelines cover some of these additional areas, yet they are still often overlooked even by professionals.
When a child perceives the world and behaves in a manner that is congruent with diagnostic criteria of ADD/ADHD there is often a rather long time pre diagnosis. Throughout this time many children may hear things like, “Calm down. You’re too loud, too much.”, “Why can’t you just sit down, be still and do your homework?!”, “We have talked about this a million times! Why don’t you understand this?” and many more. Some of this commentary may have started even before school. When school begins children suffering from undiagnosed ADD/ADHD experience one academic failure after another, continuously fail to meet expectations put on them by others or even themselves, while their peers seem to easily succeed. This has detrimental effects on the child’s self-esteem. They start realising that they are somehow different to the other children. They begin to think, that something is wrong with them as a person, that they are unlikeable and many other negative thoughts about themselves. This may lead to dramatically reduced self-esteem, and other potential mental health difficulties such as depression or (social) anxiety, excessive worrying.
Medical treatment can provide a relief from the diagnostic symptoms, however, medication does not provide the children with tools to support themselves, to help them manage when not taking the medication. Additionally, medication fails to address the psychological damages that may have (more often than not) occurred before the child/teenager (or even adult) has been diagnosed.
The NICE Guidelines do actually specify,
“1.5.13 Offer medication for children aged 5 years and over and young people only if: their ADHD symptoms are still causing a persistent significant impairment in at least one domain after environmental modifications have been implemented and reviewed.”
However, as mentioned before medication is often the first line of treatment as it provides a quick fix.
According to research and from experience lots of ADD/ADHD symptoms can be managed effectively without medication to the satisfaction of the client, the family as well as schools, by providing information about ADD/ADHD, specific individual or group coaching/training for parents of children with a diagnosis of ADD/ADHD, implementing environmental modifications, as well as therapy for the individual client covering areas such as self-organisation, self-management, emotional regulation, social skills and problem solving.
In some cases medication may still be helpful.
I know this seems like a rather large list, however, the impact of working with the individual and their system (the family (and teachers)) provides effective long lasting results.
These results build a solid foundation for the rest of their lives and enables young people to thrive, rather than just fixing the observable problems!
There are a million more things I would like to say about this. But I want to keep this blog short. If you have any questions or comments please do contact me!
In summary, ADD/ADHD should be treated using a combination of the available and above described methods depending on the individual presenting difficulties.